Serum keratin 18‐M65 levels detect progressive forms of alcohol‐associated liver disease in early noncirrhotic stages

• Published in: Alcohol, clinical & experimental research clinical & experimental research, 2023-06, Vol.47 (6), p.1079-1087
• Main Authors: Maccioni, Luca, Horsmans, Yves, Leclercq, Isabelle, Schnabl, Bernd, Stärkel, Peter
• Format: Article
• Language: English
• Subjects: Alcohol; Alcohol use; alcohol use disorder; Biomarkers; Drinking behavior; Fibrosis; hepatocellular injury; Keratin; Liver diseases; liver histology; noninvasive evaluation; Rehabilitation; Steatosis
• ISSN: 0145-6008; 2993-7175; 1530-0277; 2993-7175
• DOI: 10.1111/acer.15081

Background and Aims The progression of alcohol‐associated liver disease (ALD) in its early precirrhotic stages can be a silent process. Serum keratin 18 levels (K18‐M65) predict severe events and mortality in advanced stages of ALD, but data on this biomarker in early stages are scarce. We evaluated the diagnostic accuracy of K18‐M65 levels in identifying early forms of ALD. Methods We prospectively evaluated two cohorts of actively drinking patients with alcohol use disorder (AUD) following a rehabilitation program (training (n = 162) and validation (n = 78)) and matched healthy controls (n = 21). Clinical, laboratory, and imaging data were used to distinguish AUD patients with simple steatosis (minimal ALD) and steatohepatitis/fibrosis (early ALD). We measured serum K18‐M65 levels and assessed their ability to predict early ALD. Results High levels of K18‐M65 characterized AUD patients with early ALD, while levels in the minimal ALD group were similar to those in healthy controls. K18‐M65 levels distinguished minimal liver disease from early ALD (AUROC = 0.8704; p